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Food Allergies and Food Addiction

Last week I wrote about the CME presentations at an obesity course put on by the American Society of Bariatric Physicians. I saved the most controversial one for last. Dr. Kendall Gerdes is a former president of the American Academy of Environmental Medicine, which I have previously written about. The AAEM is not recognized by the American Board of Medical Specialties and is categorized by Quackwatch as a questionable organization. Dr. Gerdes spoke on food allergies and food addiction.

I wasn’t convinced: I thought much of what he said was questionable. I thought, as a challenge for our readers, it might be an interesting exercise to present his information without comment and let readers look for flaws and form their own opinions. At the end, I’ll offer some suggestions of things to think about.

He described the concept of food addiction as a powerful tool to free patients from compulsive eating. Patients may “have the experience of” being addicted to foods or have symptoms of hunger and of just not feeling well. Specific symptoms of food addiction include fatigue, fibromyalgia, GI symptoms, cardiac arrhythmias, asthma, rhinitis, arthritis and seizures. There is no “gold standard” way to diagnose food allergies. He relies mainly on avoidance and challenge.

 Heroin Addiction: A Model for Foods

  • As long as the junkie gets the “right dose” at the “right time,” he has no symptoms.
  • If too small a dose, or too long an interval, will get withdrawal symptoms.
  • Over time, the interval shortens and the needed dose increases.
  • If the junkie is having withdrawal symptoms, the “right” dose gives immediate relief.
  • After heroin is out of the system, a previously tolerated dose will now cause symptoms.
  • Symptoms for food addicted patients follow the same pattern. The addictive food seems “good for me” and makes them feel better.

He says that research shows that partial digestion products of milk, wheat, soy and other proteins bind to brain endorphin receptors.

Patient Presentation

  • Trouble with weight.
  • Possibly otherwise no complaints.
  • Subtle symptoms may be multiple.
  • Key feature is variability (random or same time every day)
  • Will not know they are addicted.
  • Symptoms come when they have not had the food.
  • “Favorite” food seems to relieve symptoms

Foods to Suspect

  • “Recent” foods (since agriculture) like grains and milk products
  • Foods heavily used in our society (coffee, chocolate, soy)
  • Foods where patient had allergy as a child that was “outgrown.”
  • Examine diet diary looking for heavy reliance on a few foods used 2-3 times a day.
  • Watch for multiple forms (milk, cheese, yogurt, ice cream)
  • Foods related to known food allergen
  • Foods family members don’t tolerate.

Elimination and Challenge

  • Avoid all suspect foods for 7-10 days
  • If all addictive foods are removed, patient feels better
  • Watch for withdrawal symptoms
  • If no withdrawal symptoms and/or patient not better
  • Check for adherence to elimination diet
  • Check what foods were used to replace suspect foods
  • Challenge after 7-30 days avoidance
  • If a challenge makes symptoms recur, patient is easily convinced
  • Easily missed food reactions:
    • “I really feel wonderful” from initial stimulation, followed hours later by “downer.”
    • “Gee, I’m thirsty” – reactions dump fluid into tissues
    • “Same old, same old” – symptoms are so familiar, patient doesn’t recognize that they * came after a time of no or low symptoms
  • List all symptoms, even if you don’t think they’re due to the food challenge

He offers elaborate rules for grading severity of reactions and deciding how soon to re-challenge.

Avoiding the “Next” Addiction

  • Remember patient has an addictive pattern
  • Limit members of the same food family
  • Avoid daily use of any food
  • Watch out for foods patient “loves”
  • Develop a list of food options such as quinoa, amaranth, parsnips, jicama, lichi nuts, cuttlefish, taro, nuts like pine, filberts, macadamia, etc.

Candida

There were a number of slides in the syllabus that the speaker didn’t get to. They indicated that he believes in “the yeast connection.” Lab tests are unreliable, so he makes the diagnosis with a clinical trial of a low-yeast, no sugar diet followed by challenges with foods that he thinks promote yeast growth in the body (milk, wheat, beer, mushrooms, fruit, sugar, etc.) He treats “yeast overgrowth” symptoms with elaborate and very restrictive “low-yeast” diet rules and anti-yeast medications like Nystatin and Amphotericin.

Try It, You’ll Like It

In a private conversation before his talk, Dr. Gerdes told me how he spends an hour with each patient and feels that the benefits justify the extra money he has to charge them. He mentioned one patient who was very grateful and insisted he had helped her when he hadn’t really done anything but listen to her. In his talk, he advised audience members to do their own elimination diet. If you have a positive reaction, you will be better able to see addictions in patients as well as ridding yourself of bothersome symptoms.

Instead of a Conclusion, Food for Thought

I invite readers to examine this material and form their own conclusions. Consider psychological factors, placebo/nocebo responses, confirmation bias, possible confounding factors, the meaning of “allergy” and “addiction,” what we know about physiology, the lack of blinding in elimination/challenge trials, the unreliability of “in my experience” recommendations, and the possibility that inadvertent collusion between patient and doctor might lead to deceptive conclusions. Can you spot any logical fallacies? Is the food addiction hypothesis a falsifiable one? How could it be properly tested? I look forward to an interesting discussion in the comments.

Posted in: Nutrition

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35 thoughts on “Food Allergies and Food Addiction

  1. DevoutCatalyst says:

    I’m 6’1″ and weighed 103 Lbs in 1984. So I do consider psychological factors, and consider that maybe the yeast connection with its “don’t eat this, don’t eat that” guilt tripping can have negative consequences in some patients. Anorexia as a side-effect of food allergy treatments, has it been addressed? Oh, and that ketoconazole kicks like a mule, pardner.

    I know, the singular of anecdotes is…

  2. Kultakutri says:

    I’m not a doctor, nor do I play one on TV so please don’t laugh if I say something particularly stupid.
    The whole thing seems implausible. I’d say that just about anyone in our cultural milieu spent years eating bread and similar products and I bet that it’s not bread and butter to which people would be ‘addicted’ but cake and chocolate and similar treats. If I’m right, then there are a few possibilities. Giving the author the benefit of doubt, it may be that people report craving for chocolate because they like it, it’s tasty, it’s a fast sugar fix and he mistakenly built his hypothesis of food addiction around this. Or, if I’m to be mean, the author plays on gullibility – everybody eats, everybody feels lousy from time to time. If there are Terry Pratchett’s fans, then the best thing I can get out of it is akin to Granny Weatherwax’ headology.
    Also a substance addiction is addiction to, erm, substance. Ethanol, not eggnog. So, being addicted to, say, mashed potatoes means being addicted to potato starch or palmitic acid. Also the mechanism of addiction, the increased tolerance, somehow doesn’t fit in. It would mean that the older one gets, the more breakfast cereals (or bacon and eggs) would they need.
    I guess that the food addiction concept is psychological. I’m not an expert on addiction any more than I’m a doctor but alcoholism runs in my family and I’ve had many chances to observe alcoholics in their natural habitat. I have some wine from time to time, one can say that I drink regularly, twice a week-ish but I’m no way addicted. Alcoholics either drink to keep a stable level of alcohol in the system, or when given the chance, they work their way through all alcohol available, liquor pralines and everclear included. Damn, I had an uncle who drank my mother’s cologne on one occasion. I’ve never observed such behaviour in people regarding food – not outside the realm of eating disorders which are an unrelated can of worms.
    Regarding allergies, I didn’t really understood the point – allergy to a certain food means that I’m addicted to that one or allergy to anything means that I’m addicted to some food? One way or another, it would sound as another punishment for gluttony.
    I can’t provide real arguments why the hypothesis doesn’t work but it does indeed turn all my bullshit detectors on. And I’m curious whether Daedalus would have some nitrogen oxides explanation.

  3. colli037 says:

    Multiple flaws right from the start of the comparison to heroin:
    -People take heroin to get high, there are multiple other psychologic issues driving their use, not just avoiding withdrawal symptoms

    -Patients taking opioids for pain control (a better comparison) rarely have an increasing need for more and more opioids. (called tolerance, this is NOT addiction). Patients with organic causes for pain almost never become addicts.

    -”Addiction” is the result of a specific drug-receptor interaction in opioid addiction, leading to down regulation of the opioid receptor.

    -addiction to behaviors (risk taking behavior, like gambling, or sexual activity) is related to changes in the dopamaine pathways in the brain, and is not specific to the activity. Best example of this is the increased in risk taking behavior seen as a side effect from some of the dopamine agonists used to treat parkinsons disease—different patients have different behaviors that all represent inappropriate risk taking

    This looks like the typical view of opioids expressed by someone who doesn’t know what they are talking about.

    Show me a “placebo” controlled trial showing physiologic changes related to absence of a specific food (and not just general starvation).

  4. weing says:

    Is this a joke? I’d want my money back if it wasn’t entertainment. Aren’t we all addicted to food? I can imagine going 30 days without food and then overdosing on even a small amount like kids with kwashiorkor.

  5. As an aside. I have a three friends who avoid wheat due to intolerence/allergy (I’m not sure which, sorry). One says that his sinus/allergy symptoms cleared up when he stopped wheat. The other two say they get very bloated and felt ‘weird, fuzzy or kinda stoned’ when they eat wheat products. One of the later has diagnosed celiac. I’ve always wondered if these symptoms are something documented by SBM or an alternative thing.

  6. Kristen says:

    One glaring problem I see, he is confusing food intolerance with allergy. I am quite sure a person with a real allergy to a food would only try that food once.

    Develop a list of food options such as quinoa, amaranth, parsnips, jicama, lichi nuts, cuttlefish, taro, nuts like pine, filberts, macadamia, etc.

    This made me think; “Why all the uncommon foods? I wonder why he didn’t list common, easily acquired and inexpensive food which are just as healthy? This, to me, sounds like the typical ‘if it didn’t work, it is your fault, you didn’t follow the rules’.

    My biggest worry about his approach is persons following his advice may develop nutrient deficiency and/or a different eating disorder (orthorexia). Not fixing the problem by tying to understand the underlying reason, but exchanging one problem for another.

  7. Oh yes, and I’m addicted to coffee. :) It’s an addictive substance. I don’t know what his point is in that regard.

  8. Drat, somehow I deleted a good part of my comments before submitting.

    I also said…

    I like the idea on the open ended article.

    In addition, reading the heroin comparison make me think that a better way to look at the symptoms he’s describing is compulsive eating. Addictions and compulsion do not necessarily include an external chemical dependancy. Hand washing and checking in OCD are two examples of things that do not have a chemical (or food) component but are very difficult to stop. There are some good therapies for compulsions available that could be useful here. The whole method of tracking down particular foods seems random to the point of useless.

  9. Bogeymama says:

    Sounds alot like the recommendations of the Jenny McCarthy set – wheat-free, casein-free fixes all behavioural issues. It’s very concerning for people with “real” allergies because the promotion of these ideas dilutes the issue. My son has anaphylactic milk allergy, and I live in a town with more naturopaths per captia than most (including 1 that has been promoting is “DAN” status in the local paper). There are several kids that claim milk & wheat allergies in the school, but none carry Epipens. They have no special precautions in place about avoidance of their “allergens”. Basically, they don’t need special precautions because THEY ARE NOT ALLERGIC. Then the teachers wonder why I’m so strict ….

    Some Moms have admitted to me that their MD’s were suggesting ADHD / meds for their children, so they hightailed it to the naturopath, dropped wheat and milk from the diet and *presto* the kids behaviour has changed. Therefore …. they’re allergic! No IgE testing, no RAST, just something they can grab onto that isn’t stigmatizing.

    Very frustrating….

  10. mikerattlesnake says:

    Is there even anything here to criticize? I can’t even make out a distinct hypothesis for a pathology OR a cure. Every symptom or sign seems to be worded as vaguely as a horoscope. It seems to be presented in a way that pretty much any patient with more dollars than sense would go “THAT SOUNDS JUST LIKE ME” followed by a treatment plan that amounts to the proverbial “see what sticks” method.

  11. Galadriel says:

    For the “why all the unusual foods” above, I think I might know what that’s about. I don’t know if it’s got SBM-type evidence to back it up though, just know the procedure.

    In dogs, trying to work out a food allergy, the typical procedure is a food elimination diet. You take away all the foods the dog has ever eaten before, and give him only novel sources of food. There are diets out there made specifically for this, with duck, sweet potato, etc as ingredients.

    If the dog improves, you assume that he was allergic to SOMEthing he was eating before. You then add back in, one per week, the foods he was eating before–until he has a reaction (itchy, losing hair, lethargy, digestive upset). Then you assume that the food you added before the reaction is one to which he is allergic. There may be more than one allergy, but you know to avoid that particular one in the future.

    I have a dog who starts chewing on his feet (itchy), gets scabby skin, loses hair, and gets nasty diarrhea if he eats beef. Ick. I think this is actually food intolerance, but it does make him itchy as well as the severe digestive upset, so I don’t know. It doesn’t really matter to me, as long as we avoid letting him have anything with any beef.

    I’ve been dealing with this for the past few days, in fact, because I accidentally grabbed a wrong can of food at the store last week and didn’t realize it until he came down with the squits. (Ugh. It SAID “chicken and rice” but it had stealth ingredients. Poor pup.)

  12. superdave says:

    This was almost science, but it didn’t get really bad until the patient evaluation section, where it is totally revealed that it isn’t.

    He makes a testable claim that symptoms will be reduced after the following procedure.

    Then he says

    # Easily missed food reactions:

    * “I really feel wonderful” from initial stimulation, followed hours later by “downer.”
    * “Gee, I’m thirsty” – reactions dump fluid into tissues
    * “Same old, same old” – symptoms are so familiar, patient doesn’t recognize that they * came after a time of no or low symptoms

    # List all symptoms, even if you don’t think they’re due to the food challenge

    So basically, even if the symptoms i mentioned in the begnnining of this talk don’t go away or even appear, if any of these other symptoms also appear, i’m still right.

    totally unfalsifiable (or at least, pretty damn hard to falsify)

    I think in general people can become addicted to food, but is probably psychological and not physical.

  13. Bogeymama – Great point about diluting the meaning of allergy. My mom was allergic to shellfish and bee stings. Her reactions were severe enough that her doctors recommended carrying an epipen because they were concerned her next accidental exposure could result in Anaphylaxis. So I am accustomed to taking exposure to allergens seriously.

    That said, I avoid giving some preservatives to my daughter. She seems to get (really) wiggy and moody when she eats foods with sodium nitrates and/or calcium propionate. Honestly, I can’t prove there’s a real connection, but it’s just easier for me to buy the food without those things than wonder. (have fun with that, guys.)

    What I don’t do, is tell people that she has an allergy, because she doesn’t. I completely understand that, even if there is a true connection, having those foods isn’t going to hurt her. It will only give her, or me or the teacher a bad day. I just do my shopping and pack lunches and call it good enough. It seems the parents you are talking about could take a similar tack.

  14. I read something awhile ago that made a strong argument about how easy it is to mis-diagnose celiac and other food allergies using an avoidance/challenge protocol. The claim was that if you avoid a certain type of food for a length of time, your intestinal ecosystem will evolve away from processing that food. When you reintroduce the food, you get sick: not because you are truly allergic, but because your intestinal flora needs time to readapt to the food. This phenomenon, of course, confirms the suspicion of food allergy.

  15. James Fox says:

    It would appear that not only am I a food junkie, I have a terrible addiction to water and oxygen. It would appear there is no hope so I’ll just have to accept my limitations and persevere as beast as I can, and have a big stiff G&T when I get home.

  16. Franklin says:

    I’m not sure I get it – is he saying that food allergies can be treated as an addiction?

    Is he saying that if you are addicted to a certain food in your diet that you may not know what it is, like if you didn’t know what nicoteine was?

    I am about as close to addicted to fried chicken and Little Debbie Cakes as anyone could be. But is it really an addiction? They are really delicious and sometimes I get an uncontrollable urge to have some, but doesn’t everyone have that? And maybe the sugar rush of sweets gives me a big short-lived burst, but are the hunger, and then the rush not just normal physiological reactions? I mean, at 4 pm my body is experiencing a lack of glucose and Little Debbie Cakes fill that need, albeit not in the best way. (For the record I’m skinny, and not diabetic)

    I think the flaw is that food is a necessary requirement for the body to function. If you really really liked 30% oxygen and cumpulsively sought it out rather than the normal 20%, would that be an addiction or just an exagerated normal process? What about drinking 10 cups of water a day? How is it different from just really wanting something a certain way? Like if you just can’t eat your toast without a ton of butter? Or if you always put way too much salt on your fries?

    If these could be categorized as addictive behaviors, it seems to me the problem is the behavior or an underlying anxiety factor, not the specific food ingredient.

    All things in moderation, right? The folks that are supposedly addicted to tanning ( <a href="http://www.time.com/time/health/article/0,8599,1983141,00.html&quot; Link ) still need UV rays, they just need to do it responsibly.

    I don’t know…

  17. StonesOnCanvas says:

    I’m just a lowly lab tech (although I am applying to medical school currently), but I just love doing this stuff. Feel free to correct me if I miss anything or have incorrect information:

    His heroin addiction model is hilarious. I just can’t help but laugh at someone when they compare food to heroin.

    “He says that research shows that partial digestion products of milk, wheat, soy and other proteins bind to brain endorphin receptors.” I do not know the ‘research’ he is claiming but regardless of that, I do know that proteins are broken down into amino acids prior to being absorbed into the blood stream (therefore no “partial digestion products” are absorbed)…AND this is also completely ignoring the blood brain barrier which restricts the diffusion of large or water soluble molecules.

    His specific symptoms are hardly “specific” at all. The over-inclusive and ultimately meaningless label, “Fibromyalgia” is a vague catchall pain syndrome. Everyone gets GI symptoms, fatigue, and rhinitis (runny nose). And then he just throws in some random symptoms: cardiac arrhythmias, asthma, arthritis and seizures. And don’t be too surprised if he isn’t just limiting himself to these “symptoms”. He also suggested that hunger and “just not feeling well” could also be due to food addiction.

    Patient presentation is also extremely vague. If “trouble” with weight is the only required criteria, then this nearly everyone I know (not just obese, or overweight, but also those with fluctuating weight or those who are underweight). Then he states, “Symptoms come when they have not had the food.” What does that mean!? That is so prone to confirmation bias that it isn’t even funny. What does he mean by “not having had the food”? Not having it for an hour, a day, a week, a month…? Thus said symptom is likely to occur during this poorly defined time frame. Likewise “Favorite food seems to relieve symptoms” is highly prone to selective recall.

    Obviously he suspects the foods that are most common in our diet. Then he starts to merge his food addiction model with (his poorly defined) food allergy concept. This is now starting to go downhill fast. Addiction is characterized by physical withdrawal symptoms which are caused by physiological adaptation in the central nervous system and brain due to chronic exposure to a substance. Basically the brain has adapted to a particular substance being present all the time (usually does so by opposing the drug’s effects) so when you reduce the dose or stop altogether, you get the opposite effects of the drug (Heart rate changes, blood pressure changes, depression…). Allergy is an immune reaction. It’s totally unrelated!

    Now his big Test: Elimination and Challenge. No blinding whatsoever and again prone to confirmation bias and selective recall. Positive results are so inclusive as to be meaningless. “Gee, I’m thirsty” – common really!? “Well shucks, I’ve been thirsty before…therefore I’m a food addict” (well yes, I have to say, I am physiologically dependent on food). And the icing on the cake: “Same old, same old” – symptoms are so familiar, patient doesn’t recognize that they came after a time of no or low symptoms”. So even a negative result is probably the positive result you never knew you had. Common, what better way is there to make a test utterly unfalsifiable? He also tells you to “List all symptoms, even if you don’t think they’re due to the food challenge”. As we already discovered, any and all symptoms you list (from “tired in morning” to “comatose”) are due to food allergy/addiction (I just can’t decide which one).

  18. Calli Arcale says:

    micheleinmichiganon:
    As an aside. I have a three friends who avoid wheat due to intolerence/allergy (I’m not sure which, sorry). One says that his sinus/allergy symptoms cleared up when he stopped wheat. The other two say they get very bloated and felt ‘weird, fuzzy or kinda stoned’ when they eat wheat products. One of the later has diagnosed celiac. I’ve always wondered if these symptoms are something documented by SBM or an alternative thing.

    Hard to say; I have a relative who has severe celiac sprue, so I’m somewhat familiar with it. The symptoms are gastrointestinal, not behavioral, though having pain in your GI tract can make anybody irritable. It’s a straight-up genetic condition: people with celiac sprue have a genetic flaw that causes their immune system to be unable to distinguish between the “kill me now, I’m infected” signal and an alcohol that is one of the products of digesting gluten (and also some related chemicals). Severity varies; I’m not sure why. This is why some celiac sufferers can go decades without diagnosis, while others (like my cousin) wind up in the hospital with an ileus the first time they try solid food. Diagnosis involves biopsy of the intestinal lining; they look for the characteristic damaged caused by the immune system going all medieval on the cilia.

    There is no treatment except avoidance of foods that, when digested, produce the chemical that their bodies will mistake for a “kill me now” hormone. It is NOT limited to wheat, and you can usually tell a real case of celiac sprue from a fake one by whether or not they realize just how many foods are really affected. My cousin can’t even use vanilla extract. (Interestingly, gluten itself doesn’t elicit this response. It’s the digested products, which get absorbed into the gut, which call out the armies.)

    The genetic defect responsible for celiac sprue is hereditary, and recessive (so both parents must carry it).

    One can also be allergic to wheat. A person who is allergic to wheat will have different symptoms (allergic ones), and will probably not be bothered by other plants that contain gluten, or related chemicals as long as they’re not contaminated with whatever wheat protein their immune system has flagged. Unlike celiac sprue, this is treatable with antihistamines, unless it’s a severe allergy in which case the person ought to carry an epi-pen. (Epi-pens are useless against celiac sprue, though.)

    So gluten intolerance and wheat allergy are both real. But there is all the same a large alt-med fascination with both. Some attribute autism to gluten intolerance (and/or casein allergy, which is not the same as the much more common lactose intolerance), claiming that the gluten damages the intestinal walls, causing a “leaky gut” that allows toxins to enter the bloodstream and damage the brain. But gluten does not damage the intestinal walls, even in people with celiac sprue — it’s a faulty immune system doing the damage. And it doesn’t cause the gut to become “leaky” and allow toxins in — quite the contrary. One early symptom is often signs of malnutrition in a person with adequate dietary intake — their guts are so badly scarred they aren’t absorbing food effectively. Of course, if undiagnosed for long enough, the gut *can* become leaky — it can be so badly weakened that it actually ruptures, which is a surgical emergency.

  19. KB says:

    It seems like you should set up a test that eliminates some confounding factors, like the amount of fiber in the diet. If you go from a low fiber to a high fiber back to a low fiber diet, you might get some “symptoms” at the changes. You could have “withdrawal” GI upset when you start the new diet, and then “food reaction” GI upset when you try the old one out again.

    Also, a lot of people are lactose intolerant. Some people are lactose intolerant to different extents, so they can drink a small amount of milk with their cereal but get sick if they down a pint of ice cream. It wouldn’t be hard for those people to feel better when they avoid dairy and feel worse when they eat it again, but it’s not an allergy or an addiction.

    If reactions dump fluids into tissues, shouldn’t you look for edema? It seems like thirst would be a rougher indication. And is he accounting for the difference in sodium intake? (Probably not.)

    It seems like anything could happen, and it would support his theory. The patient may present with just trouble with weight, which the majority of America would probably agree they had. After they go on the elimination diet, they either feel better or have withdrawal symptoms: so they either feel better or worse, or both. If they feel the same, they’re blamed for not sticking to the diet, and there doesn’t seem to be any discussion about their not having a food allergy in this case. After the challenge, they can feel better or worse, or both, or the same because they’re too unaware to recognize their symptoms. There’s no sign available that can be not-present: feeling the same is just evidence that you don’t know what feeling good is like. He doesn’t provide a way to rule out a food allergy. That’s weird.

  20. LovleAnjel says:

    I wish I had notes on how he fleshed out his bullet points, some of them don’t make sense. Heroin as an analogue? Really? I love me some Twix, but in no way does that even approach a chemical high. One of the key things to look for is an interference in daily life & relationships. Unless you are skipping work to sit at home & eat cake, you are probably okay.

    Patient Presentation

    * Trouble with weight.
    Pretty much 100% of patients can say this.

    * Possibly otherwise no complaints.
    Okay. If there are no other complaints, then this is not a problem worth addressing.

    * Subtle symptoms may be multiple.
    What is a subtle symptom?

    * Key feature is variability (random or same time every day)
    This is where I get lost & annoyed. A key feature is everything is…different & unpredictable? Not the same in any way from patient to patient? Doesn’t that make every set of symptoms/complaints a sign of food addiction?

    * Will not know they are addicted.
    Most addicts KNOW they are addicted, they just deny that it is a problem. Most people who crave a specific food will know their craving and even jokingly refer to it as an addiction. I think this is in here so that, again, any patient can be diagnosed.

    * Symptoms come when they have not had the food.
    Those vague, subtle, random and variable symptoms? I bet.

    * “Favorite” food seems to relieve symptoms
    As does a myriad of other things, like playing with a pet or hugging a spouse or child. Just because something relaxes you does not mean you are addicted to it.

    Foods to Suspect

    * “Recent” foods (since agriculture) like grains and milk products
    Those are recent foods? They have been in the human diet about 8000 years. I guess they are geologically recent.

    * Foods heavily used in our society (coffee, chocolate, soy)
    This broadens the diagnosable group to any person who walks in the door for any reason.

    * Foods where patient had allergy as a child that was “outgrown.”
    If I had not been allowed to eat peanut butter as a kid, you bet I’d be all over it now (I pretty much am anyway).

    * Examine diet diary looking for heavy reliance on a few foods used 2-3 times a day.
    That would be bread, milk, ect. Having toast for breakfast & a sandwich for lunch is not the same thing as having multiple hits of coke.

    * Watch for multiple forms (milk, cheese, yogurt, ice cream)
    So my skim milk is as addicting as ice cream? Interesting…I often crave one right after the other. Perhaps the skim milk is a stronger hit? The ice cream isn’t the “right dose”?

    * Foods related to known food allergen
    All foods are related to a known food allergen.

    * Foods family members don’t tolerate.
    My dad hates fish. Can’t even stand to smell it. It seemed so exotic and luxurious that I came to love it pretty quickly. Again a case of wanting something you were never allowed to have as a child.

    Elimination and Challenge

    * Avoid all suspect foods for 7-10 days
    * If all addictive foods are removed, patient feels better
    * Watch for withdrawal symptoms
    What are those, exactly? We know what withdrawal from heroin, nicotine, ect is like. What is withdrawal from milk like? Or are we again subject to variable and subtle symptoms?

    * If no withdrawal symptoms and/or patient not better
    So if it didn’t actually work…

    * Check for adherence to elimination diet
    The patient must have screwed it up!
    * Check what foods were used to replace suspect foods
    Because they might be one of the “multiple forms” or “related to a known food allergen”.

    * Challenge after 7-30 days avoidance
    * If a challenge makes symptoms recur, patient is easily convinced
    No doubt.

    * Easily missed food reactions:
    o “I really feel wonderful” from initial stimulation, followed hours later by “downer.”
    I worry about this “stimulation” (snicker snicker). This is a standard emotional/psychological response to trying something new. You get all excited, spend lots of time thinking about how awesome it will be and you’re doing something positive, then the “high” wears off and you get annoyed by the extra effort, time & money involved. People have this exact same reaction to getting a gym membership, starting a diet plan, or pretty much any other endeavor.

    o “Gee, I’m thirsty” – reactions dump fluid into tissues
    ?? Everyone gets thirsty! Every day! Several times a day! Especially if they have cut out milk & soda & are thus drinking less than normal.

    o “Same old, same old” – symptoms are so familiar, patient doesn’t recognize that they * came after a time of no or low symptoms
    I don’t know what to make of this. This basically allows that HAVING NO CHANGE is also a positive result! So if you have a change in symptoms, you are addicted. If you have no change in symptoms, you are addicted and too stupid to figure it out.

    * List all symptoms, even if you don’t think they’re due to the food challenge
    Hoo boy better get yourself a big notepad.

    Sorry it devolved into snark there. Basically, this whole thing is written so that any person who comes to see the doctor for any reason (even if they don’t have a reason, I fear for those who pop in to update their insurance info) will be diagnosed as addicted to food. Any symptom is a symptom. No symptoms is a symptom. Symptoms are subtle, random, variable, and not consistent from patient to patient. If you change your diet, any reaction or lack of reaction is a positive. If your symptoms go away? Check. Symptoms simply change? Check. No change at all? Check.

    Everybody is addicted, especially those who don’t know it.

    Like other posters, I am angered by referring to an intolerance or major dislike as an allergy. My friend has children with multiple food allergies. Breathing in peanut smell makes them anaphylactic. Her daughter cries in pain when they drive through corn fields (no kidding). Totally not the same thing as getting stomach pain & gas from bread.

  21. Happy Camper says:

    Harriet

    I have the same problems with Dr Gerdes “symptoms” for food allergies as LovleAnjel and that is they are all over the place. Shouldn’t the symptoms for a food allergy be somewhat the same for all allergies?

    Wouldn’t the first step to identify a allergy be to do the (most common, easiest and fastest) skin test first and if that is not conclusive move on to blood testing for a safer approach?

  22. Calli Arcale- Thanks for the run down on celiac. I did not realize it was a kind of autoimmune disease.

    Regarding tests for food allergy tests. Somewhere it seems I read or heard that there are a lot of false positives in food allergy tests. Is this skin tests or another kind. Is that true?

  23. Bogeymama says:

    Skin testing isn’t perfect, but it is considered more accurate than the RAST or blood testing. But the allergists use these tests as benchmarks, and combine these results with a patient’s history.

    For example, they know that if a Total IgE is declining year over year, and a patient’s blood test result for a particular food is significantly lower than prior years – it may signal that the patient is “growing out” of an allergy. Combine that info with a negative skin test, and you’ve got grounds for an “oral challenge”, which is the only true allergy test. So while no single test is truly diagnostic, the allergists can look at several “clues” to come up with a pretty clear picture.

    This testing is in contrast to the different types of testing that naturopaths and Chinese Medicine docs offer – like IgG testing (which gives people a whole long list of things they’re allergic to and almost always include wheat, milk & corn…), or strange things like Vega testing. THOSE types of tests are definitely not accurate.

    Symptoms of true food allergy are like other allergy symptoms, and are not related to hyperactivity, or vague stomach upset. They are immediate, and frightening. Sometimes people have more minor and chronic reactions, like eczema, but these are a non-IgE type of allergy, and are the kind that kids typically grow out of.

    One of the posters above is absolutely correct when they say that if a person with a true food allergy feels better after the food is removed, it would take an awful lot of convincing to get them to try it ever again!

    And micheleinmichigan – thank you for not calling your child’s sensitivities an allergy. Dr. Scott Sicherer has written an excellent book which explains the differences between food allergies and what you describe (which he describes more as chemical reactions, not allergies). Unfortunately, every practitioner of “woo” LOVES to use the word allergy to describe everyone’s ailments, because people will believe it. How many times have I heard “Oh yes, I know someone with lactose intolerance, that can be rough”. Yes, I’m sure it can. But not as bad as real milk allergy, where you see your child struggle to breathe after taking a single bite of a hot dog, turn purple from head to toe and pass out from lack of oxygen, after which he turns to the person he trusts the most in the world – his Mother – and accepts her apology for insisting that he take a bite because it’s “safe”.

    That is why I think it’s dangerous to call intolerances allergies. Sadly, many of my well-educated friends believe all that their natural practitioners tell them. One of them even suggested I take my son to her “Energy Healer” to cure his allergies. Ummmm, yeah, no thanks. His allergies are “real”, not imagined.

  24. Sastra says:

    # If all addictive foods are removed, patient feels better
    # Challenge after 7-30 days avoidance
    # If a challenge makes symptoms recur, patient is easily convinced

    Well, the entire list has pretty much been taken apart, but I wanted to point out that this looks like a recipe for subjective validation. I assume the patient is told exactly what to expect when the “addictive foods” are removed, and warned about what may happen when they’re brought back. If you’re dealing with someone who is the least bit suggestible (e.g. pretty much everyone), they are very likely to please the doctor and themselves by discovering that they have the ‘right’ experiences, each time.

    I am tempted to ask Gerdes to try the simple experiment Ray Hyman once tried with palmistry: see what happens when you tell the patient to expect the exact opposite of what you think will happen.

    Of course, I’m also a bit confused about how a patient who presents with no other complaint but “trouble with weight” is going to be able to talk about how their symptoms are getting better, or worse. What symptoms? Their weight? I imagine that if an “addictive” food like ice cream, cookies, or Doritos is eliminated from the diet for a while, weight will go up again after they are eventually re-introduced. Not sure what that has to do with the song and dance about addiction, though.

  25. Mino says:

    I think the addiction-theory has already been tested:

    Dopamine D2 receptors in addiction-like reward dysfunction and compulsive eating in obese rats

    Paul M Johnson & Paul J Kenny

    Nature Neuroscience 13, 635–641 (2010)

    I think this might clarify something. Here the link:
    http://www.nature.com/neuro/journal/v13/n5/abs/nn.2519.html#/

    :-)

  26. Robin says:

    Bogeymama wrote:

    Symptoms of true food allergy are like other allergy symptoms, and are not related to hyperactivity, or vague stomach upset.

    Right! I seem to have a food allergy but as of yet have not identified the particular food. It’s happened infrequently over the last few years. The symptoms occur during the course of a meal and are: instense abdominal pain, followed by [painful and unpleasant bathroom bodily function] during which I break out in hives. Allergy, to me, implies the necessity an antihistamine.

    Dr. Gerdes presentation doesn’t seem to be about allergies, and, as far as I can tell addiction has never been implicated in disease. His list of illnesses and symptoms are all of the chronic, tough to treat variety (with the exception of seizures and cardiac arrhythmias!) and seem to attract all kinds of strange ideas about nutritional intervention.

  27. bogeymama- thanks for info on types of allergy tests. I’ve heard of various people getting allergy tests and was confounded at what seemed to be very different reports on results. Your explanation clarified things for me.

  28. passionlessDrone says:

    Hello friends –

    I’m not sure what I have, but I do know the following:

    1) If I eat something with wheat in it, I start coughing within five minutes. Eat a bunch, cough a lot. Sometimes, it comes alongside a runny nose.

    2) Usually there is a day or two of pain down the way [haven't tried in a while.]

    3) After an infraction, I (re)develop dark circles under my eyes. (My wife could always tell if I’d cheated).

    I got an IgE (or IgG?) test, which listed wheat as a high risk (3 out of 4), but was negative on celiac test. Other stuff hit, but the other bad offender is cashews (also a 3 out of 4) which have me coughing anytime I touch them, which sucks.

    Curiously, I seem to have developed the immediate reactions in the past few years after some exceedingly stressful events, though I carried dark circles under my eyes for pretty much forever until I went GF.

    Do I have food allergies, or food sensitivities, or what? I don’t know, but I have figured out that if I tell the waiter I’m allergic to wheat I can count on getting something that won’t have me hacking, but if I ask them if there is wheat in the dish, their answer is not necessarily meaningful or relayed to the chef. I’m not sure if this means I am misrepresenting my condition, I’m not sure I care.

    - pD

  29. passionlessDrone – huh. I’m just a layperson but dark circles and coughing are what I get with sinusitis and asthma (cough varient). The thing about asthma (I’m told) is that is can be triggered by a big varieties of things, allergens, irritants, exercise, stress, sinusitis, viral infections, etc, ad nasuesum.

    I’m sure I’m being presumptuous and once again I’m not a doctor, but, if it were an asthma response to wheat, it might not be a bad idea to talk to your doctor about it, maybe it would be good to have an emergency inhaler prescribed to have on hand in case of accidental exposure. Mine is very helpful for the asthma related coughing fits.

  30. BobbyG says:

    Two of my long-time favorite books are “The Flight from Science and Reason,” and Peter Huber’s ( Rest His Soul) “Galileo’s Revenge: Junk Science in the Courtroom.” Reading all this stuff brings them to mind, particularly the post about the AAEM.

  31. mas528 says:

    I am not a doctor. Nor am I a scientist.

    It sounds like he is making somewhat true statements, but couching them in the language of addiction.

    – As long as the junkie gets the “right dose” at the “right time,” he has no –symptoms.

    This sounds like a meal that is sufficiently caloric to maintain weight. I mean whatever weight you are, 110lb or 500lb. Eating more kcal than your maintenance kcal makes you gain weight, eating less, you stay hungry.

    –If too small a dose, or too long an interval, will get withdrawal symptoms.

    This sounds suspiciously like ‘getting hungry’ and “not eating enough”.

    –Over time, the interval shortens and the needed dose increases.

    Well, if they are have gained weight, they need more kcal to maintain that weight. As I recall, all tissues, including fat, respond to deprivation, and will send signals to the brain that say, “eat more”.

    –If the junkie is having withdrawal symptoms, the “right” dose gives –immediate relief.

    Except that is given by injection (or drip) directly into the blood supply.
    For the over eater, this is not true at all. It takes some time for the process of digestion to work and get to the blood stream. There is no immediate.

    –After heroin is out of the system, a previously tolerated dose will now –cause symptoms.

    Yes, if you have lost weight and are living comfortably on a 3200 Kcal diet, and your meals are generally around 1000 kcal, the previous 2000 calorie meals will make you gain weight.

  32. woo-fu says:

    A dietitian associated with an allergy clinic once explained the food allergy/addiction angle this way: the allergic response brings on a rush of chemicals that amp up the body, and, as long as the allergy level is low, a class 1 or 2, the manifestation of the allergy may be subtle, and the body begins to crave the food in order to feed the response. Like downing a double shot mocha, the body gets a boost, followed by a crash, which can lead to the desire for another boost. Compare this to a higher class allergy where the response is so blatant and uncomfortable, the likelihood of addiction is minimal and the danger of the substance more obvious.

    Whether or not the term “addiction” is a good choice for this explanation or even if the explanation is cogent, I’m not in a position to judge. However, it does seem that not only are these theories of food addiction, as presented here, being used as the basis for a cure-all, they muddle any distinctions among intolerance, true allergy and autoimmune responses to food.

    On a side note, people can develop severe food allergies later in life as scientists are just discovering. For example tick bites correlate with the sudden appearance of true food allergies in adults with delayed and often serious consequences to vulnerable individuals: http://www.washingtonpost.com/wp-dyn/content/article/2009/10/19/AR2009101902874.html This discovery is changing some very basic assumptions about the way food allergies manifest.

  33. Dacks says:

    My understanding, and I would like to be corrected if I am wrong, of the difference between allergies and intolerance is that an allergic reaction involves an over-reactive immune response, whereas lactose-intolerance, for instance, is caused by an insufficient production of lactase, the enzyme that digests lactose. As far as I know, lactose intolerance does not involve the immune system at all.

    So, these two conditions are not related, even though they may have symptom overlap in the case of mild allergy. I developed lactose intolerance as an adult, which causes me no trouble if I avoid milk, milk based soups, ice cream and yogurt. I enjoy small amounts of cheese and buttermilk; I think these are tolerated more easily because the lactose in them is already partially digested.

  34. Kultakutri says:

    Erm, speaking of allergies, if I may add another two cents, not all allergic reactions include anaphylactic shock or something dramatic. My not-really-dramatic episodes of runny nose, swollen eyes and a bit of hives here and there developed in not-really-dramatic asthma. I’m not happy for that, nor am I happy when I’m told I’m not actually allergic to, say, almonds or tobacco smoke because I don’t die upon ingesting the former or inspiring the latter, nor do I change colours in interesting ways.

    I also admit to not making difference between intolerance and allergy. In some situations, it’s easier than explaining in length that this intolerance thingy, although it doesn’t trigger IgE response, will make me sick like hell. There are people who can hold only a certain amount of knowledge and good enough that they understand that allergy = miserably sick.

  35. Calli Arcale says:

    passionlessDrone:

    1) If I eat something with wheat in it, I start coughing within five minutes. Eat a bunch, cough a lot. Sometimes, it comes alongside a runny nose.

    2) Usually there is a day or two of pain down the way [haven't tried in a while.]

    3) After an infraction, I (re)develop dark circles under my eyes. (My wife could always tell if I’d cheated).

    I got an IgE (or IgG?) test, which listed wheat as a high risk (3 out of 4), but was negative on celiac test. Other stuff hit, but the other bad offender is cashews (also a 3 out of 4) which have me coughing anytime I touch them, which sucks.

    I’m a software engineer, not a doctor, but that really sounds like an allergy to me. I’d see an allergist. If nothing else, it would be good to get counseling on how to tell if your symptoms are getting worse, which could put you in danger of anaphylaxis (which can kill you).

    Safest approach to an allergy is avoidance of the offending protein(s), especially since some allergies have a nasty habit of getting progressively worse with each exposure. You may be able to benefit from allergy shots, which retrain your immune system to lay off on those particular proteins, but they don’t always work.

    Have you tried antihistamines? If it’s an allergy, they should relieve your symptoms. Benadryl (generic name: diphenhydramine) is one of the most reliable, but tends to make people groggy. Claritin (generic: loratidine) is non-drowsy. I find I get the fastest relief from Zyrtec (generic: cetirizine) but I also find it wears off the most quickly, though other people get all-day relief from it. There are lots more. Tavist (clemastine) is another that I’ve used successfully. I know some people with severe food allergies, and they use either an epi-pen or Benadryl in the event of accidental exposure, and then get to a hospital ASAP.

    Your real problem may not be gluten, BTW. Do you have problems only with wheat? Is barley okay? If so, the problem is not gluten, but probably some protein in the wheat. It may not matter for practical purposes (either way, you need to avoid wheat) but knowing the specifics might help warn you if you need to avoid anything *else*.

    I don’t know, but I have figured out that if I tell the waiter I’m allergic to wheat I can count on getting something that won’t have me hacking, but if I ask them if there is wheat in the dish, their answer is not necessarily meaningful or relayed to the chef. I’m not sure if this means I am misrepresenting my condition, I’m not sure I care.

    When speaking to waiters, precision isn’t as important as safety. They’re more likely to understand “allergy = bad” than “intolerance = bad”, so I think that’s perfectly acceptable. The main thing is that they know you shouldn’t have ingredient X, and whatever you have to tell them in order to achieve that is good in my book.

    Kultakutri:

    Erm, speaking of allergies, if I may add another two cents, not all allergic reactions include anaphylactic shock or something dramatic. My not-really-dramatic episodes of runny nose, swollen eyes and a bit of hives here and there developed in not-really-dramatic asthma.

    Yeah, that’s a pretty classic allergy response. Anaphylactic shock will only occur in a severe allergy. Most allergies are much less serious. My citrus allergy is very mild, for instance, but to avoid making it worse, I avoid citrus fruit for the most part. I also use antihistamines if I am accidentally exposed, or if I’m deciding to live dangerously and enjoy a nice lemonade or a Mimosa. ;-)

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